Provider Demographics
NPI:1760103121
Name:WHARTON, CARA BARRY (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CARA
Middle Name:BARRY
Last Name:WHARTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HILLCREST BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2559
Mailing Address - Country:US
Mailing Address - Phone:415-948-9962
Mailing Address - Fax:
Practice Address - Street 1:1425 BROADWAY STE 14
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3435
Practice Address - Country:US
Practice Address - Phone:650-267-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44784106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist